Utilization Review Nurse

Irving, TX

Category: Utilization Management Job Number: 647 Pay Rate: 70,000

Utilization Management / Review Nurse - Irving TX 

We are currently looking for an experienced  Utilization Management Nurse in Irving, TX. The  Utilization Management (UM) nurses will provide our clients with appropriate and comprehensive utilization of health care services and benefits as designated.  This is a contract to hire opportunity. 

$60, 000.00 - $70, 000.00 annually DOE

Responsibilities:
  • Pre-Certification of emergency, urgent and elective admissions and the determination of length of stay based on age, multiple or single diagnoses, and the nature of the diagnosis.
  • Concurrent review and the determination of the extension of the length of stay based on the severity of illness and the intensity of service.
  • Assist with Discharge Planning to ensure compliance with benefit plan and use of preferred providers/networks.
  • Identification of alternative treatment plans, which are to be approved by all parties.  These alternative care plans will be based on quality care within cost containment guidelines allowing available claims dollars to be used in the most judicious manner possible.
  • Evaluate the cost effectiveness of the elected treatment plan, pre-implementation and post- implementation.  This outcome measurement will be used in determining the effective results and in establishing future patient-centered care plans.
  • Medical record review to determine medical necessity of requested services.
  • Interpreting individual health plans and authorizing/coordinating care in accordance with plan provisions.

 

Requirements:
  • Graduate of an accredited school of nursing 
  • Current TX state RN  license. 
  • Professional background in clinical nursing and patient assessment.
  • Minimum 3 years prior experience in utilization management or case management preferred, preferably within the managed care environment.
  • Knowledgeable in medical terminology, reasonable and necessary treatment plans, delivery of quality health care services and cost containment practices.
  • Proficiency in maintaining good rapport with physicians, health care facilities, clients and providers.
  • Ability to effectively and collaboratively work as a team member with non-clinical teammates.

#CSM

Erica Escobar
Clinical Recruitment Manager

As the Clinical Recruitment Manager for CornerStone Medical, Erica provides a custom, specialized candidate experience while making her hiring managers needs a top priority. After attending the University of New Mexico, where she focused on Business Management, she learned the skillful art of recruiting to help people obtain their dream career and match them with premier companies.

Erica has over ten years of recruitment and staffing experience, with the last eight years focused on healthcare. She has worked for multiple Fortune 500 companies including, IBM where she was responsible for staffing the United Healthcare account, before becoming a corporate recruiter for Cornerstone Healthcare Group. While at CHG she was responsible for staffing clinical, allied health, administrative and executive level roles for 26 acute care facilities nationwide.

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